Hypertension | Cheat Sheet

University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

369

Pages:

5
Author:

Mariam A. A.

Hypertension Epidemiology Primary aldosteronism is the most common curable cause of secondary HTN Major threats to Life/Serious Cause MI Acute pulmonary edema SAH Aortic dissection PET/eclampsia Hypertensive encephalopathy Catecholamine crisis Acute renal failure Immediate Management For acutely symptomatic or have a serious cause Oxygenation Need a saturation of more than 94% IV access Senior help Acute lowering BP with IV drug is rarely needed If needed should only be in ICU or CCU Oral agents are usually enough Choice depends on cause, acute symptoms, age and past medical history Treat specific acute pathologies Further history and examination if patient are asymptomatic with no other acute clinical features Clinical features of end organ dysfunction Chest pain SOB Palpations Edema Sudden severe headache Confusion Visual changes Weakness Foamy urine Reduced UO Blurred vision Blind spots Examination Findings Investigations FBC Polycythaemia Anaemia CKD U&E LFTs Urine analysis Beta hCG for women of childbearing age (PET) Proteinuria -> PTE, nephrotic syndrome, glomerulonephritis Haematuria -> renal HTN, glomerulonephritis, nephritic syndrome ECG MI, chronic HTN with LV hypertrophy CXR Cardiomegaly Evidence of heart failure Widened mediastinum -> aortic dissection If features of end organ dysfunction Should have additional investigations directed towards that CT angiography for renal disease CT scan for renal mass Management Aims: 140/90 for patients who need BP lowering therapy Nondrug management For all patients Regular aerobic exercise Reduction of alcohol intake Moderate Na+ restriction Healthy eating Weight reduction When to Start BP Lowering Therapy Based on BP and cardiovascular risk More beneficial in patients with high cardiovascular risk than low cardiovascular risk Patients with high or moderate cardiovascular risk Not routinely needed for patients with low cardiovascular risk First line drug classes: ACEI E.g. captopril ARBs E.g. candesartan Dihydropyridine CCBs E.g. amlodipine Thiazides and thiazide like diuretics E.g. chlortalidone Choice is influenced by patient factors such as comorbidities and ADRs: ACEIs or ARBs for patients with heart failure with reduced ejection fraction Dihydropyridine CCBs for patients with stable angina Second line classes Beta blockers Nondihydropyridine CCBs Centrally acting alpha 2 agonists Direct acting vasodilators Drug therapy can be: Single drug therapy ay low or moderate dose Two drugs at low dose Isolated HTN Exclude end organ dysfunction History, exam, urinalysis, ECG, renal function Identify cause Cause specific management Complications CHF LVH Hypertrophic cardiomyopathy AFiB Aortic dissection Carotid artery stenosis Atherosclerosis Stroke TIA Subcortical leukoencephalopathy Cognitive changes e.g. memory loss Kidney Hypertensive nephrosclerosis Chronic kidney disease Hypertensive retinopathy